Abstract:
BACKGROUND:Angiotensin-converting enzyme inhibitors (ACE-Is) are a widely used class of cardiovascular medication. However, limited data exist on the risks of postoperative nonresumption of an ACE-I. OBJECTIVE:To evaluate the factors and 30-day mortality risks associated with the postoperative nonresumption of an ACE-I. DESIGN:A retrospective cohort study. SETTING:Veterans Affairs (VA) Healthcare System. PATIENTS:A total of 294,505 admissions in 240,978 patients with multiple preoperative prescription refills (>3) for an ACE-I who underwent inpatient surgery from calendar years 1999 to 2012. INTERVENTION:None. MEASUREMENTS:We classified surgical admissions based upon the timing of postoperative resumption of an ACE-I prescription from the day of surgery through postoperative days 0 to 14 and 15 to 30, and collected 30-day mortality data. We evaluated the relationship between 30-day mortality and the nonresumption of an ACE-I from postoperative day 0 to 14 using proportional hazard regression models, adjusting for patient- and hospital-level risk factors. Sensitivity analyses were conducted using more homogeneous subpopulations and propensity score models. RESULTS:Twenty-five percent of our cohort did not resume an ACE-I during the 14 days following surgery. Nonresumption of an ACE-I within postoperative day 0 to 14 was independently associated with increased 30-day mortality (hazard ratio: 3.44; 95% confidence interval: 3.30-3.60; P < 0.001) compared to the restart group. Sensitivity analyses maintained this relationship. CONCLUSIONS:Nonresumption of an ACE-I is common after major inpatient surgery in the large VA Health Care System. Restarting of an ACE-I within postoperative day 0 to 14 is, however, associated with decreased 30-day mortality. Careful attention to the issue of timely reinstitution of chronic medications such as an ACE-I is indicated.
journal_name
J Hosp Medjournal_title
Journal of hospital medicineauthors
Mudumbai SC,Takemoto S,Cason BA,Au S,Upadhyay A,Wallace AWdoi
10.1002/jhm.2182subject
Has Abstractpub_date
2014-05-01 00:00:00pages
289-96issue
5eissn
1553-5592issn
1553-5606journal_volume
9pub_type
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